fu ling or hou po

[Guest guest]

CASE:

 

Your patient presents with chest and epigastric distension, abdominal

pain, nausea and

loss of appetite, asthma and wheezing with sputum, slippery pulse, and

slimy tongue

coat.

 

What single medicinal would

you choose that best addresses all of these symptoms and signs?

 

a) chen pi b) fu ling c) hou po d) shan zha e) huang lian

 

 

A student wrote: You asked for the best answer and mine was fu ling,

and you said that it was hou po......Okay, I think I

disagree based on Wiseman pg. 213, 7.1, Damp Phlegm

 

" Damp Phlegm is a pattern characterized by cough and

copius, white phlegm, and is attributable to splenic

transformation failure " ......

 

Wiseman lists chen pi first, fu ling second (my

choice) and hou po as third.

 

I believe that fu ling is by far a better choice than

hou po because based on the top functions listed of fu

ling:

 

" Strenghthens the spleen and harmonizes the middle

burner-splenic TT failure "

 

If in fact we were to use just ho po (which in the

real world is not the case), there would only be a

transformation of the phlem, BUT hou po would not be

the answer to the root cause which is the need to

repair the spleen because it is failing to transform

properly. Fu ling actually strengthens the spleen, hou po

does not, it is a great mover of qi stagnation, and

that is all.

 

 

I replied (comments please, feel free to disagree):

 

fu ling is not indicated for wheezing and asthma. your first

obligation is to relieve suffering, not correct the assumed root, so

hou po is best. In addition, the patient has no vacuity signs, so

relieving damp and phlegm is all that is necessary. Thus, any herbs

that disencumbers the spleen will do here. You are assuming the spleen

needs fortifying, but there are several causes that don't present with

vacuity. I can guarantee you that if you gave this patient fu ling and

neglected to give him hou po, he would have zero relief from his

suffering. the only symptoms fu ling relieves quickly are urinary

irritation and loose stool. Wiseman's order may not be one of rank,

but rather alphabetical in this case (c comes before f comes before h).

I wouldn't assume any implicit hierarchy. But perhaps the missing

piece here is whether one addresses the damp and phlegm strongly or

should focus primarily on the spleen. Chen pi would also be a better

choice than fu ling for the same reason. It would also dry up the

phlegm and relieve the chest and epigastric distension very quickly.

 

I believe there is something else you have missed and perhaps this is

due to our focus in class on functions more than indications. Just

because an herb has a function does not mean it is good at addressing

every symptom that could be related to that function. For fu ling,

under its function of transforming phlegm, symptoms listed include

palpitations, headache and dizziness, which typically occur when phlegm

invades the head. Note the absence of actual respiratory symptoms.

When used to treat chest distension and actual mucus or sputum it is

always combined with herbs like zhi ban xia and chen pi. If an

indication for an herb is only listed as part of a combination, it

often means the herbs does not have the function by itself. But if you

look up ban xia and chen pi, you see they are both used for chest

distension or stifling by themselves, thus they must be the herbs that

do this in the combination with fu ling. Fu ling is just used in these

combinations to address the root and open an exit way for the damp.

But it contributes very little to short term symptom relief. I think

the crux of the matter is you want a qi mover here, not a spleen

strengthener, as your first choice. The chief complaint involves pain

and distention, which means stagnation. You need a spicy herb to break

up the stagnation here, not a sweet or bland herb.

 

Having said all that, fu ling would likely be an ingredient in the

final formula, buts its role would be as an assistant or deputy, not

the chief.

 

 

 

 

[Guest guest]

On Mar 13, 2005, at 12:34 PM, wrote:

 

> fu ling is not indicated for wheezing and asthma. your first

> obligation is to relieve suffering, not correct the assumed root, so

> hou po is best.

 

Your definition of the practitioner's obligation doesn't apply to

everyone. I look at it this way, the first thing I HAVE to do is

generate some relief from the chief complaint, or as you described

" relieve suffering " . Once that's been done, you can begin to devote

some of the formula to the root because now your patient is on-board

for a longer haul.

 

This is really a question of case management. If your patient is

committed, on board, willing to go to the mat for you, why not add the

fu ling and address the underlying root? Going to have to eventually.

 

And of course in clinical reality, at least with my scanty years of

practice, I can't **know for certain** which treatment principle is

going to be the quickest for any given patient. I do agree with the

Chen Pi and Hou Po for this patient (didn't this topic arise about a

month ago on this list?)

 

> I can guarantee you that if you gave this patient fu ling and

> neglected to give him hou po, he would have zero relief from his

> suffering. the only symptoms fu ling relieves quickly are urinary

> irritation and loose stool.

 

Fu Ling calms the spirit. Sometimes when you can't fix the pathology,

you can alter the perception of it by calming shen to alleviate

suffering.

 

> But perhaps the missing

> piece here is whether one addresses the damp and phlegm strongly or

> should focus primarily on the spleen. Chen pi would also be a better

> choice than fu ling for the same reason. It would also dry up the

> phlegm and relieve the chest and epigastric distension very quickly.

 

However there is no root described in your case study. Lacking that, I

can see where one would want to assume a Spleen involvement. I see no

indications of deficiency, but the " profound saying to guide your

clinical practice " (as Dr. Jiang Fu Zhang would say) is that the earth

element creates the damp and the metal element stores it.

 

--

 

Pain is inevitable, suffering is optional.

-Adlai Stevenson

[Guest guest]

I think your student's experience below confirms my own observations that

students tend to get sidetracked by too many examples of herb combinations in

the basic materia medica. If they would only focus on the basic properties of

each herb and understand them well, they would know not only how to make the

most effective choice but also how to combine, with a few special exceptions

that require explicit mention.

>>>>Roger

That needs to come out of the clinic. That is the only realistic place one can

really learn how to write an Rx.

 

 

 

 

[Guest guest]

What is the name and ISBN of your book?

 

 

 

[Guest guest]

, Al Stone <alstone@b...> wrote:

>

 

>

> This is really a question of case management. If your patient is

> committed, on board, willing to go to the mat for you, why not add the fu ling

now

 

 

I think you missed the point. It was a best herb question in a mt med class,

not writing rx.

I told the students in clinic you would use both, but if you had to choose one

herb to

address the symptoms (say as an addition), hou po was best.

 

[Guest guest]

Eric when is your MM going to be published? who is publishing it?

 

 

 

 

[Guest guest]

, " "

<alonmarcus@w...> wrote:

> Eric when is your MM going to be published? who is publishing it?

 

Paradigm, in the late fall.

 

Eric